Building a More Profitable Aesthetics Practice: Margins, Planning, and Growth

Erica Crawford

Okay, we're gonna go ahead and get started here. First off, thank you so much for joining us today. So this is the webinar that we're doing. We're really excited to talk about financial planning, so making sure that you understand your margins and things like that for building your cash pay or aesthetic medical practice.

So first off, I am Erica. I'm the president here at Influx Marketing. I am joined by the wonderful Jessica Nunn. She is the CEO and founder of Maven Financial Partners. We love them. We have a lot of clients together who use them for financial planning, figuring out their margins, and everything relating to financial planning.

So she's joined here today. Truthfully, this area is much more her expertise than mine. So I'm gonna go first, cover a few slides, talk about it a little bit, but then I am going to give her the stage because financial planning is what she does, and that is what we're here to talk about.

So first off, actually before I get to my next slide, you're gonna have questions as we go along. I really want your questions. So I'm gonna give my slides for a few minutes, then I'm gonna turn it over to her. She has about a twenty-minute presentation for y'all. And then at the end, questions and answers.

As you think of them, put them into the chat, put them into the Q&A. We will get to them. I don't care what the question is, how specific it is. We love that. It's our favorite part of a webinar because it helps us think of things that maybe we didn't cover, and it's the biggest thing we can give to you, is to answer any questions that you might have. So feel free to fill those out at the end. So we're gonna get started.

So first off, most of you have a med spa or plastic surgery practice, and let's just talk about medical aesthetics. It's booming, right? There's about one point six million surgical aesthetic procedures performed annually. There's twenty-eight million non-surgical aesthetic procedures performed annually. The market is worth about forty billion, depending on who you ask, but it is in that range.

And there's over ten thousand medical spas operating in the United States. For the record, I think there's about sixteen thousand Starbucks, so it just, you know, it's catching up very quickly to the number of Starbucks that we have. Over the last five years, demand, the growth in our market has gone up forty percent, and it's only growing.

So as this market grows, there's a lot we have to cover about how to open a practice, how to get your practice to grow. If you plan on an exit, which we could also talk about, how to get your practice ready to sell. You know, there's a lot of different things you have to factor, depending on what stage that you are in your practice. But this field is growing. It's never been a better time to be in the medical aesthetics field.

Now, with that said, with more demand is more competition, right? There's thousands of new med spas have opened the past decade. There's more providers offering injectables and aesthetic treatments, and patients, simply put, have more choices than ever, right? And with that come advertising costs, which continue to rise, right?

You have Google Ads, Meta Ads, different things, and they cost more in this space because there's more people bidding on it than there was five years ago. So it's a little bit of a catch-22, where there are far more patients available for us to procure and to get. At the same time, there are also a lot more choices that they have.

So it's often where somebody goes, "You know, I've been in practice for ten, twenty years, and I always did A, B, and C, and it worked for me, and now it's not." And it's like, well, okay, cool. You know, six years ago, pre the pandemic, you had maybe ten competitors in your city that were serious competitors, and now you have a hundred serious competitors.

So how do we figure that out? How do we make sure that you're not spending too much on your marketing, that you're reasonably financially planning, and that you have a better growth margin and profit margin than you did before? And that takes a little bit more figure out than it did a few years ago, and we're gonna give you tools to help you with that.

So this is just a couple things I've noticed. Jessica will get into more of these things. But sometimes people get really excited about things. They go to a conference, they talk to a sales rep, they see certain devices. And I will say, one of the areas that I feel people often lose profit on is buying a device that's not right for either their market or their market and their practice.

So for example, you're looking at various laser resurfacing devices, and you have a ton of different options on what to do. And then as a provider, you often end up buying it based off of which device you like the best, which in a perfect world, that's totally understandable, and it should be that simple. But there are some other questions, meaning which device has the most brand recognition in your city?

What does Google Trends say about it? Like how many people are searching for that device currently, right? What is the average—what is, what does it cost on ads? Meaning do thirty of your competitors have it and you're all bidding on the same keywords for the same device, or maybe just a handful of your competitors?

There's a lot to look at when purchasing a device in terms of does it make sense for your market, your patient base, and in your practice? And that's something that not everybody thinks about 'cause it's more of an emotional decision because they just like how the device is. And while I wish it was that simple, it's just something you have to think about.

And it's very easy to do this level of research. Like it's very easy for you to pull up Google Trends or pull up a Google Ads account and sort of see how much traffic there is regarding a device, or a keyword and get an idea in your market if it makes sense or not. So I always advise if you are gonna buy a new device, or rather not even just a new device, but you're gonna add any form of procedure into your practice, see how much search there is for it, how much patient interest there is compared to how much your competitors are doing it or not doing it.

And that's really where you're gonna win in terms of adding really anything into your practice. One other thing that I'm gonna part before kind of getting to with Jessica is marketing percentage. This is such a big variable. I have clients who spend one percent of their revenue on marketing. I have clients who spend twenty percent of their revenue on marketing.

And the truth is, is that there's no hard and fast number. It depends on a number of things—what growth stage you're in. Are you a brand-new practice? Are you at a happy place where you're just kind of cruising along? Are you in a heavy expansion level? Are you trying to get your practice attractive to investors, attractive to PE companies to buy?

'Cause that's also a different marketing strategy if that's your goal. These are all various things that will require a different percentage of your revenue, right? And also the city you're in. If you are in a small town in Alabama versus Beverly Hills, you're just going to have to spend more on marketing in Beverly Hills and a higher percentage just because it's more competitive.

And these are things that are really important. If you don't know what your marketing spend is, that's kind of step zero. You should have a percentage of what that is. You should know, yes, I'm spending 6%, 7%, 10%, 15%. And then you look at what that is, and you should be able to know the ROI by every channel.

You should be able to know, okay, I'm spending X on marketing. And for the record, marketing doesn't necessarily just mean, when I'm talking about marketing percent, it doesn't just mean what you're hiring a marketing agency to do, right? That would also be your personnel, right, your marketing staff, your ad spend. It's everything. It's not just your SEO agency or something like that.

It is every dollar that you are spending to procure patients into your practice. And not everybody does the math. Matter of fact, I ran into this practice not too long ago that just had a really high percentage of revenue spend, way higher than it should be. And I couldn't make sense of it, 'cause their ad spend wasn't very high.

Their spend with us wasn't very high. They had a social media company. That didn't feel that high, so I was like, how is their number so high? And they'd had four internal marketing staff, and it was a lot for that size of a practice, and they were expensive. They were all very well paid but redundant. Like, why do you need that many staff?

Especially if you're also on top of having those staff outsourcing your SEO, outsourcing your ads. Like, why don't you just have one marketing manager who also does your social media, and then you hire a company for SEO or ads? Like, you could divide and conquer on different marketing channels, or if you wanna have four staff, they better be doing everything.

There should be no marketing agency involved, right? Like, that was where they were losing it. Matter of fact, about 80% of their marketing spend were going to their staff costs, which is why they didn't have enough money for ads or SEO or anything else. So you really have to look at the whole picture and then decide what do you do in-house versus outsource.

Is it sometimes you're not at the stage to have a full-time marketing person, you're not there in your practice, and it's cheaper actually to outsource something than it is to spend 70, 80k salary plus benefits, taxes, et cetera, on a single person. So you just have to factor all of those things and just keep in mind every market's different. It's gonna be different for your practice.

Your marketing decision impacts your profitability. Your marketing budget is a large chunk of your revenue, right? But it is the thing that brings you in new patients. So you really have to be smart about every channel you're doing and making sure that you're looking at your ROI from each channel.

If you're running paid ads, you should know exactly how much you're making from paid ads. If you're doing SEO—SEO can be a little bit of investment 'cause it can take a few years to get to page one and things like that, but you should be looking at it over, let's say, maybe a three to five-year window and going, "Okay, is this making sense? Is this gonna get me enough patients?"

If you're doing a social media, whatever channel you're doing, it needs to make sense because you are spending a decent amount of your revenue on that, and make sure that your margins are there. And Jessica is gonna talk about this a lot more, so I'm gonna kind of turn it over to her. I'm gonna talk to you about this last slide a little bit later, but Jessica, over to you.

Jessica Nunn

Thank you. Well, you know what we're gonna do today to start, you guys, is at that ground zero, because for me to help you guys understand how to create a profitable practice, you have to know where you are today. So I really want... That's my goal for the call today, is for you guys to really get clear on where you are today and know how to do that.

And then as we're going through it, like, let's talk about where you should be, but we have to know where we are today and know where we should be to understand the gap and what needs to happen, right? So I'm gonna spend some time really talking about where we should be first. I'm Jessica Nunn. Thank you, Erica.

You're making me really wanna dig into our marketing spend, I will say that. But founder, fractional CFO here at Maven Financial. We help clients understand their numbers is really the nuts and bolts of it. So, we're not the CPA, we're not the bookkeeper, we're not doing the QuickBooks, but what we're doing is taking that information along with the key performance indicators, which we're gonna talk about what the heck that is today, to help you make the next right decision in your business.

So what do we need to do based on the numbers? A lot of people can tell you what the numbers are, right? But the strategy is in what we need to do based on what those numbers are. So we call ourselves a fractional CFO. What is that?

So, like I said, we're not the bookkeeper, right? Bookkeeper tends to keep your QuickBooks, focuses on the current. Your CPA oftentimes is doing your tax returns, telling you how you did last year. A CFO focuses on the future. We want to help you with the future.

So let's talk about real quick what you need to look at in terms of your numbers. First of all, I want your P&L to be organized in a way where you can quickly and easily see what's working in the practice, what's not working in the practice, okay? 'Cause again, we gotta figure out where we are now in order to know where we need to go, and if your P&L is like a jumbled mess, then it's really hard to determine where you are now.

So when we first start working with clients, we get a copy of their P&L. We actually get the access to the accounting software. But oftentimes the P&L is a jumbled mess, kinda like our before picture here, right? You guys didn't know that financial statements could have before and after pictures too, but they sure can.

So let me show you what a jumbled mess might look like. Here is a P&L, my before picture P&L, right? So I'm looking at this to try to figure out—Are we profitable? How do we get to be profitable? So as I'm going through the P&L, I'm like, "Wait, okay, let's start with payroll," right?

What's our payroll in this business? Two hundred and forty-two thousand. Is that good? Wait, here's more payroll. Now I gotta do math. Wait, here's more payroll. Now I gotta do more math. Right? So our payroll is spread out all over the place in this P&L, which requires me to do math, add all these numbers up, then try to determine if I'm spending the right amount on payroll, and if payroll is a problem in my business.

So then moving on, what's the next thing we might look at? Oh, inventory and supplies. That's a big one. Everyone feels like they're spending too much on inventory and supplies. So when we're analyzing that, we might look here, but then wait, now we've gotta look over here too, but then... Professional fees, that's the next one, right?

Let's see if we're overspending here. It's here in the middle of the P&L, but then wait, we have duplicate categories over here too. This is an example of a P&L that's going to be really hard for you guys to understand if you're doing well and what you need to do to become more profitable. So let me show you how we can better organize this thing. We'll walk through it together quickly.

What we like to see is all of your income here together, and we don't just wanna have one line item that says income. To Erica's point about margins, we wanna understand how profitable each of your service lines are. So in order to do that quickly and easily, that's the goal. I know you guys aren't trying to look at your P&L for hours every month, right?

You just wanna look at it for like thirty minutes and be done. Let's have our P&L show our income by service line. So whatever your top four or five services are in your practice, have your accountant share that in your P&L. How is my revenue? How does it come in? How does the money come in? What services are we doing?

Then we've got our cost of goods sold here. So our cost of goods sold is the supplies and consumables that it takes to generate that revenue. We want to show those in the same buckets of revenue that we have, right? So we can easily see our profit on laser services is this.

Our profit on injectables and fillers is this, right? I'm not having to do like a hide and seek in the P&L to find all the costs, and then it's not even giving me the right thing. So we really wanna break out our income and our cost of goods sold based on the categories of services that we provide. Then next, the next probably most important thing in the business is payroll.

So we wanna see our providers separate from our admin team, right? Maybe you show MAs separate as well, nurses if you have them. Like, whatever the categories of payroll are for your practice, let's show that. Also, if you're an owner and you're a provider as well, if you're injecting or producing in some way, let's have your salary broken out too.

And the reason for that, you guys, is that if you're an owner of a business, usually you pay yourself based on what your CPA says, right? You're paying yourself not based on the production that you're doing, 'cause you own the business, you don't care. You're paying yourself the amount that your CPA wants you to pay for tax purposes.

So oftentimes we find that the owners of the business are working for free, right? If you feel that, or for a very reduced rate. So we really wanna normalize what would your payroll be if you didn't actually own the business. We need to normalize your owner payroll before we can decide if overall your payroll is too high.

So keep that in mind as I'm going through this. You need to understand how much you produce and what your payroll would be if you were in fact paying yourself that fair rate. It's not gonna be in your P&L. That is some math that you might have to do on the side. We can talk about that more if you guys want. But we wanna understand your total payroll. Together, no hide and seek to find the expenses.

Bank charges and merchant fees, that... You know, we wanna see that. That's an important cost. You'd be surprised at how quickly it adds up. We call these things on the left side of the P&L our variable expenses, because as our revenue increases, we expect these costs to go up, right? You do twice the amount in fillers that you did last year, that cost is gonna go up, your cost on those supplies.

Probably you're gonna pay your injectors a little bit more too. So we know that these costs are gonna increase as our revenue goes up, and we are okay with that, okay? We don't freak out when that happens.

Now on the other side of the page, we have our fixed expenses. So these costs should not go up as our revenue goes up, right? Our rent does not care how many patients we saw. It is what it is, right? Same thing usually with IT, legal and professional insurance, and here's where we like marketing to go, okay?

So we consider marketing a fixed expense. We'll get into some ways to analyze, you know, the cost of this in a bit. And then beyond the fixed expenses, we have our net operating income. This is actually, you guys, the most important line on the whole thing. On the whole P&L, I want you to focus on this line. So why isn't it collections?

Why isn't it revenue? Well, somebody can be generating a million dollars in revenue and not see a single dollar of profit. We know practices like that, right? Hopefully that's not the case for anybody here. But what's important is not what you make, it's what you keep, okay? Net operating income is the most important thing.

Why, though, is net income at the very bottom not the most important thing? Well, look at the items that are showing up between net operating income and net income. It's kind of your discretionary owner type expenses like your car, right? Maybe some CE that you took in Vegas because it was amazing and you brought your husband because he wanted to come.

Maybe it's depreciation and interest. These are things that don't necessarily reflect the profitability of the business. So we like to pull them out of fixed expenses and variable expenses and just show them somewhere else. That way we can have that true net operating income that's like, this is your profit, okay? Does that make sense, you guys?

So I want your P&L to be one to two pages like a resume not fifteen pages of mumbled hide and go seek P&L line items, okay? So let's have it organized two pages long and kind of in categories like this. My next tip for you is I want you to add the percentage of income so when you hear Erica, when you hear me talking about how much you should be spending, about the benchmarks, you know, what should we be spending on marketing?

What should we be spending on payroll? What should we be spending on these? You're gonna hear us talk in terms of percentages because it's all relative, right? A practice that generates five million in revenue is certainly gonna have more payroll in dollars than a practice that has one million in revenue. So we always like to look at percentages. So if we wanna see percentages, you need to see percentages.

No one's trying to do math, so it's actually a quick check mark that you can make in QuickBooks. You just check a box and it shows you the percentage of revenue. So if your accountant is not giving you your financials with the percentages, let's ask them to do that. Super important.

Here's another thing I want you to do. How do we know if in twenty twenty-one two point one million in income was good? How do we know? Because we want some context. We wanna compare it to last year. We wanna compare it to last month. We wanna compare it to this same month last year, right?

So we wanna either have this year compared to last year, year to date, or even better, like month over month. Like, you need to have more than one column of numbers here so you have something to compare it to. So you can see in this practice that your revenue went up. We're happy about that, but what the heck happened to our cost of goods sold? Look at that.

They went up a lot more. I said that they would go up when your revenue goes up, but look at the percentage. So if in twenty twenty our cost of goods sold was twenty percent of income, we kind of expect it to be twenty percent of income in twenty twenty-one also, right? That dollar's gonna go up, but we like the percentage to stay the same. So this would be something that you might dig into if this were your practice, okay? We might dig into this and say, "Why are we generating less profit from more income?" This is a problem as a percentage.

So this in the end is our beautiful after picture. We're happy to send this to anybody. If you wanna send it to your accountant and say, "Make it like this," this is what we recommend your P&L looks like, with the percentages, the years over years, month over month. Our clients actually—we turn their QuickBooks into something even prettier than this, so, they don't have to worry so much about what their accountant reports 'cause we route it into our own model which has all of this stuff of course because this is what we wanna see.

So here's our benchmarks. A lot of folks say, "Well, where should it be? Where should my percentages be?" Right? This is so relative, right? Like, like Erica said, every practice is different, every location is different, but this is kind of the guidelines that we like to start with. So retail, we want your retail to be at least ten percent, so take a look at that.

Cost of goods sold, this is the consumables, twenty-five to thirty-five percent. If you're only injectables, it might be closer to forty, but we have to look at that. Is that going to generate enough profit for you? If you're really using your energy devices well and you have a lot of service lines that you're offering beyond injectables, it might be lower.

Payroll, twenty-five to thirty-five also, right? But remember, before you decide your payroll expense is, like, really great 'cause it's only fifteen percent, normalize your own salary. How much would you have to pay yourself based on the work you're doing if you didn't own it, right? If you didn't own the place, what would your salary be? Now where are you?

Marketing, advertising, we say three to six percent. Just like Erica said. Are you in the middle of Alabama? It might be lower. Are you well-established with a super full schedule? It might be lower. Are you realizing that your problem is actually revenue, and we need to fill the rooms and fill the providers? It might be higher, okay?

All the other fixed costs you guys can see, but that net operating income I wanna see between fifteen to twenty-five percent. Most of our practices I'll say on these fixed expenses are closer to ten, so we have a lot of wins there. Beyond your P&L, how else can you decide how you're doing so you can determine where you wanna go?

We call these key performance indicators, KPIs. So honestly, you guys, when we're looking at a P&L and we're trying to make a practice more profitable, we're not like, "Stop spending money. Don't spend anything else." We don't believe that cutting costs is the key to growing a business. We really don't. So what we look at instead is are we maximizing our revenue?

And we look at it with three key KPIs, key performance indicators. We like revenue per hour, revenue per appointment, and utilization. So first, what are these things? Revenue per hour is the total revenue earned over the total amount of hours seeing patients. We're very specific about that. We wanna know how much are you generating per hour when you're seeing patients.

Revenue per appointment, the revenue earned over the number of appointments. It's different than revenue per hour, right? Are we seeing a bunch of little appointments, or are we seeing big appointments that generate a lot of revenue but maybe we have fewer of them? And then utilization, this is total hours seeing patients compared to total hours available to see patients.

So if you're at the office from nine to five, that's what you're available. If you're only seeing patients from nine to noon—Because that's the only time you had scheduled, then that's your hours worked. Okay?

So what do these things tell us about the business? You know, my partner Kristen and I say a lot that we can tell so much about your business without ever stepping foot in your office, and it's by looking at these KPIs. We can decide if your pricing is right, if it's time for you to hire somebody, if you're offering comprehensive care, if you're maximizing the schedule, how are you comparing to other providers, treatment times, all the things we can tell just by digging into the numbers.

So let's dig into them a little bit more together. Revenue per hour, we talked about this. So the average revenue generated for your practice or each provider per treatment hour. So how do we change this? Well, it's just math. We either see more appointments every hour or we generate a higher ticket price per appointment. It's your choice, right?

So you can do more comprehensive treatment planning, you can raise your fees, you can, you know, whatever it might be to increase your, your ticket price or we can really get efficient and see more people every hour. So it's one of the two things or a combination of both. Let's talk about how we like to look at it.

So if the practice's revenue per hour was seven hundred and fifty dollars for January, is that good? What if we added more months for more context? We'd see, nope, not great. What if we added individual providers? Then we could really see more context, right? We can see, huh, the problem with January was not injector one.

She did great. Problem with January was injector three. What happened? Right? Was she just getting trained? Was she brand new? Like what's happening with injector three? In February, injector three is doing a little bit better. So all of the increase is attributed to her. Same thing in March. Actually, in March everyone did great.

So we know now, huh, is everyone capable of the nine fifty? If so, what's keeping injector two and three from getting there? Right? So we wanna look at these KPIs by provider. It's really important so that you can see where you are now but what your potential is. Here's our benchmarks. This is where we like to see folks kind of average and top performing. Everyone likes this one. And we do see these rates.

Revenue per appointment. So what is that? Revenue over number of appointments. So changing this oftentimes will also change your revenue per hour, right? So there's the similar strategies to doing so, but revenue per appointment does not include seeing more patients and increasing our appointments, right?

It's truly just those things that would generate more revenue per appointment, raising fees, comprehensive treatment planning, adding additional procedures and products. Let me show you the impact of this. So say for an example, we had a month where we saw a hundred and fifty appointments. Our average revenue per appointment was five hundred dollars. Total revenue is seventy-five thousand.

What if we increase that revenue per appointment by one hundred dollars? Look at the impact of that. That's a big number, right? A big number. And if you've heard Kristen or I speak before, one thing we say is it is illegal to leave the practice without sunscreen, right? So something like a sunscreen product or any other product can bring us from this five hundred to six hundred.

So it's important to really understand your average revenue per appointment, and if we feel like that's lower than it should be—We're not clinical, right? We're not here to diagnose your patients and tell you what it should be. We're telling you what it is, and then you can decide as a business, what kind of services you wanna provide to get to that average revenue per appointment.

Utilization. So this is essentially how busy is your schedule. How busy are you? And a lot of times we're working with clients and they say, "I really need to hire someone. We are just so, so busy." And we'll look at the utilization by provider and we'll say, "Well, I know it might feel busy, but their schedule is only actually booked fifty percent of the time."

So what do we need to do about that, right? So we need to see the numbers per provider to understand if it's truly time to hire someone or if it's just feeling busy. But how do we increase utilization, right? Rebooking, offering online booking, just whatever it's gonna take to get more patients in the door. Marketing, right? Effective marketing.

We can also use utilization to tell us if your case acceptance is working, right? If your treatment acceptance, if you're, you know, really great at diagnosing and saying, "Gosh, we could do all of these things and it would get you the result you're looking for." But if patients are saying no, I wonder why that might be.

Putting it all together. So when we look at our KPIs, right? This is what it looks like for us. So we look at all of these metrics, historical, and then we use that information to make a future plan and close the gaps. So this is how we intentionally tell our practice where we want it to be and what the revenue should be compared to where it is now.

And if you're really wanting to dive into profitability and increase your profitability, I'm telling you guys, there's so many hours in the day, start with revenue. Dig into these revenue numbers before you go slashing all of your expenses, if that makes sense. I promise it'll get you a better return. But either way, right?

We're using reviewing our P&L and reviewing our KPIs to figure out what we need to do to improve our profitability. So we identify the problem—What's the real reason, right? Was our profit down because our revenue went down, or is it 'cause our expenses went up? Please don't let it be both. Right? If our revenue went down, we need to look at revenue per hour.

Or is it capacity or hours worked? Like maybe someone left and we have less providers. And then these might be the solutions based on whatever the problems are. See, you know, this is kinda how you can walk through your data to figure out what the real reason is that the profitability isn't where you want it to be. Same thing on expenses. What's the reason if your expenses are increasing?

Are we increasing our fees accordingly, right? Are we shopping around? Are we just buying every time our rep walks into the door? Do we have a budget? No one likes a budget. Are we even reviewing our P&L, right? So these might be reasons why your expenses are increasing.

So what are we gonna do about this? So we need to be an after photo on our P&L, right? We're gonna keep our financials current. I cannot tell you how many people we would love to review their financials with them, and they have it from a year ago. So you have to be able to see your financials from last month.

Understand your benchmarks, calculate and track your KPIs by the for the practice and by provider, and then we would love to do a complimentary financial assessment if you'd like some help reviewing your financials, seeing how you stack against the others in the space. Also, I thought I'd throw our book on here. We have a book about all of these things. Our book is available on Amazon.

And then we have a QR code, too, for the complimentary financial assessment. And I know Erica has one also for the website.

Erica Crawford

Amazing, Jessica. Thank you so much. That was really informative. I'm gonna have to start digging into my own P&Ls a little bit after all that.

Jessica Nunn

I know. We both can, right?

Erica Crawford

So right now I think we just go... There's a couple questions in there. Honestly, if you have anything very specific... And remember, like we're talking a lot about injectors and lasers, but for a plastic surgery practice this also applies, right? There are multiple plastic surgeons.

Jessica Nunn

True. But most of our practices have injectors, too. And what I often find with our plastic surgery practices is where they've analyzed the surgeries really well, but not always the non-surgical. And so that's an area of profitability, especially since a lot of y'all, 'cause I know some of you are here, it's just you. It's you, one plastic surgeon.

So your area where you could really grow, let's say the plastic surgeon's busy, is the non-surgical side. And this doesn't always get applied to that.

Jessica Nunn

I'll add to that, too, that the benchmarks, you guys, for a plastic surgery office are tricky, because it kinda depends. Do you have your own OR or are you paying a facility fee? Are you paying anesthesia out? Do you have anesthesia on staff? So it really depends on the specifics of your practice.

But we do have benchmarks for surgical practices, too, and we'd love to share those. And honestly, for surgical practices, for the surgeon itself, we don't look at revenue per hour. We look at case volume, right? We wanna know, are you... What's the case or revenue per surgery day, right?

And oftentimes those align in the same way. But those are a little bit different of KPIs. We'd be happy to share those with you guys as well, but the benchmarks for surgery are a little trickier.

Erica Crawford

Yeah. And you said you're offering, like, a free financial analysis. Yeah. So we can show you what that looks like. I mean, that's pretty—So if someone—Yeah, those are not easy. So just, I'm gonna, I'm gonna get into the questions, but I'm gonna put the QR codes if you want the financial analysis.

Like you can—if you're on the Rights Maven and then here less info, so if you have any questions for us. But I would take advantage of that, because you might not know where you're at. One of the questions there is, "Please give us resources on how to calculate ROI." And Jessica, I didn't know if there's any, like, tools that you suggest.

Jessica Nunn

Yeah. I'm not sure if they mean marketing ROI. I'm suspicious that they do. Is that what you think, that they mean marketing?

Erica Crawford

We'll cover both. How about both?

Jessica Nunn

Okay. Yeah. From a marketing perspective, it's fairly simple. You need to have a really good CRM. I don't actually care what CRM you use, right? What I mean by CRM is leads tracking system, right, where you can actually put the amounts and the revenue per patient.

And then if you do not do that, there is no way to calculate your marketing ROI. So if you're using GoHighLevel or Symplast or, you know, Line or... I don't care, actually. I just need you to be using one that you like, that your staff actually use. I need you to input the data because all... A CRM will tell you exactly where the lead came from.

It'll say it came from SEO, it came from Google Ads, it came from social media. It will track where it came from. Then all you have to do is go in and when they, you know, they go along the sales process, right? They go contacted, negotiations, whatever, however you have that pipeline set up.

And then at the end you go, "Okay, they're paying $600, $5,000. They got a big facelift, $40,000." And then you can calculate by marketing channel, you know, the ROI on everything. Like, typically speaking, for us, when our practices really use their CRM, 'cause no agency, no marketing person can calculate that unless you actually keep track of your CRM, 'cause that's not necessarily automatic.

There is some human involvement there. But you should be able to calculate, like, I made not only just X from a channel, right? You could say X from SEO, X amount from ads, X amount from social media. It should drill down to, like, this specific ad campaign, my TikTok, my Instagram, my YouTube.

Like, you should be able to calculate all the way down to the channel that you're using. And one of the questions here, just to add, "If you don't have a CRM at this point, what info should you track?" Minimally, where the patient came from, which is, you're just gonna have to ask them, and how much they paid, so that then you could figure it out.

Those are the two most important pieces of information that a CRM might be able to give you, in my opinion.

Jessica Nunn

And so ROI just means, you guys, return on investment. So return on investment is what, right? On what investment. So you might look at it, "What's my ROI on my staff?" So on this particular injector.

And it works the same way. You're calculating what's the revenue that person is bringing compared to their cost, right? And we like injectors to have an ROI of five times their cost. So keep that in mind. If you're paying them $50 an hour, that means that they need to generate five times that, which is $250 an hour, in order to really be providing the ROI, right?

On surgeons, it's a little bit less. It's usually two to three times, kinda depending on where they are. But that's how you calculate your ROI on your team, is how much are they bringing in, this is on providers, compared to how much you're paying them. And then on things like devices, same thing, right? When you have your revenue broken up by category, you can see.

And honestly, you should be able to pull revenue by specific device from your practice management software maybe if you're tracking it, and then you can think about what you paid for it, right? So look at it since inception, what you paid for it, and the consumables. So the real math is just figuring out, how much did you invest originally and how much revenue are they bringing in. Those are really the two factors.

Erica Crawford

Perfect. And then there's another one. So this business building webinar is great, awesome. I'm new to the aesthetics industry. One year in my new business. This has been my biggest struggle, the business end of my job. I am a single practitioner. Any advice on my very first step? Thanks.

Jessica Nunn

First of all, congrats on one year. You are not alone. I'm telling you guys, if they taught business in medical or nursing school, I would not have a business. So I am thankful that they do not, right? 'Cause it allows us to have a business helping you all, but I know that it makes you feel that you're missing some components of understanding your business.

My first step would be that you hire a bookkeeper. Hire if you haven't already. Hire someone to do your QuickBooks. You have to have that in good working order. And use your practice management software well, right? So much, Erica, I'm sure you see it too.

We dive in to pull the KPIs and it's a complete mess because no one's been trained on how to use the practice management software. So get a good start on tracking your data by having good financial statements, that's your P&L and balance sheet, and good data in your practice management, EMR.

Erica Crawford

Yeah. So a couple things, I would say. So, like, you're just, for some of you here, you're just starting out, right? It's your year one. You're starting out. You don't have enough money... You have, like, enough money to, like, pay yourself and pay your rent, right? You're like, "I'm not even—"

Jessica Nunn

Totally. Maybe not even pay yourself.

Erica Crawford

"Erica and Jessica, I'm not even there yet," right? I feel like a couple of these questions are in that category, so I'm gonna just say a couple things that are really, really simple. One is Google Reviews is the cheapest form of marketing that you could do. It is something that has extreme value. So you can, all by yourself, create a Google Business Profile, right?

You can fill it out. You take photos of yourself, your interiors, your exteriors. You load it into that Google Business Profile. It's really easy. You put your hours. You put your information. You put down all the services you have, breast aug or like if it's just injectables, injectables, lasers, whatever.

And then you get people to leave you reviews. And every patient that comes and sees you, you get them to leave a review. Every time you injected a friend just free of cost 'cause you were practicing—you make that friend give you a review. You get reviews all over the place. I would argue that right now Google Reviews are one of the strongest forms of marketing, and I will tell you why.

And I could do a whole workshop all about Google Reviews because it's so important. You have your map pack, right, your Google Business Profile. So if people are near you, if you have a lot of Google reviews and activity on your Google Business Profile, that will pop up, right? Your Google Business Profile will pop up in that little map, and they'll see you.

So even if your SEO, you have nobody for SEO or anything else, you could at least start to optimize yourself in the map pack. But most importantly, and I've done quite a few AI talks, and I will do more of them. I am constantly doing them, and I will constantly do more of them. But AI pulls from many sources on the internet, and that is a whole nother discussion.

But one of the number one places that Bard, Gemini, Perplexity, ChatGPT pull from is Google Reviews. They lean heavily on it, every single AI model that's out there. So you go, "Are there any good," you know, "Who does the best Botox in the area?" If you don't have a ton of Google reviews saying that you do the best Botox in the area, you're not gonna pop up.

So you can kind of... Like, if you just don't have any budget to start with, I'm like, just go heavy on your Google Business Profile. Just start getting lots of reviews. You could do it yourself. You don't even have to hire somebody for it, right?

And you can, you know, build that up, maybe even pull up in some AI searches yourself, and then you can start building up enough revenue to start hiring the things you need, hiring a financial advisor, hiring a marketing company, hiring the things you need. But any practice right now, I would say I don't care where you're at in your practice.

You're just starting or you've been around for 23, 20, 30 years, I would say there's almost nothing more important than Google Reviews at this exact moment in time. That could always change, but right now that's what all the AI stuff is doing. Google itself is leaning heavier onto the reviews, even for their organic SEO.

It's kinda crazy right now, and I'm like, "Well, that's cool." I'm excited about that, 'cause Google Reviews are, you know, reviews from patients, and it's cheap. It doesn't cost you anything really to get them. So you know, I, I like something that's like that when it happens in the digital landscape.

Perfect. And then, yeah, we can give a sample. Also, I'm probably speaking about this a little bit too early, but based off of some of these questions, at Amspa, Influx Marketing has always... We will always be, and our core offerings have always been, an agency approach, meaning we're very hands-on, we meet with you very regularly.

You know, you can email us, call us, text us. That is kind of been our business model, and we haven't always been, just to be blunt, we're not the cheapest agency, not anywhere close, and we're actually on the higher end of things. So some of you know that, been our client for some time. But we're pretty good, so there's a reason for that. We do everything in-house. We don't outsource anything.

But I will say, and I'm gonna say that we are—we have for the last two years been building something out that we are releasing at Amspa, which is in four weeks from now, that is a very, very inexpensive software offering that is there for somebody who is at day one, meaning they are not ready to hire a company like ours, and it's gonna be great.

And if you are interested in something like that and you're in these questions, and I'm talking very inexpensive, like very inexpensive, and you don't have any of the software or the tools right now, back to that QR code at Influx, or you could just, if you want, just put your email in the chat here. I will make sure that when we do release it, that you are reached out to, because as part of it, you are going to get all that practice management software that you need to be able to calculate some of these numbers that we're talking about. So there you go. So just put your email in—

Jessica Nunn

Yeah, all the emails here. Erica Crawford: All the emails. We'll get all the emails here. You know what I mean?

What is the best way or strategies to gather more Google reviews, knowing you can't incentivize them for compliance reasons? Thank you for saying that, Brent. First off, people get sued all the time for fake Google reviews. It is like a huge, huge thing. What's his name in Seattle? A Seattle plastic surgeon sued for like $5 million for fake reviews. It's a whole thing, by the way.

You cannot purchase or incentivize any reviews. All those software systems... And I'm gonna tell you how to do it, just give me there one second. But all those software systems that are like automated that are like, if the person puts five stars in, it directs them to Google reviews, but if they put four below, it directs them someplace else, those are all actually like highly illegal in our space. You cannot do any of that.

You just need to get honest reviews. I will tell you the number one way to incentivize reviews. It's incentivizing your staff. You give them Amazon gift cards, man. Those reviews are gold. It is worth every single penny that... They are so worthwhile.

I would give your staff a $100 gift card to Amazon or wherever they want every time they got a five-star review, every single time, and they are worth that much. They are worth more than that. And that is the best way to incentivize it, is to get your staff, because it is annoying. You're like kinda hounding somebody to put a review in. It's not exactly their job, so I get it.

But that is the best way to get them. 'Cause we have practices with like 700, 800, 900 reviews. They have a lot of reviews, and a lot of it is like the staff. It's like a whole thing. A little celebration. It's a whole game. It's like a thing, and that is the best way to do it.

Also, fun fact, Google takes fake reviews very seriously, so if you have a competitor that you think has a bunch of fake reviews, you can report them, and Google's very serious about that, so just another fun fact there.

Erica Crawford

Oh, you're muted, Jessica. Jessica Nunn: Sorry, I was just excited. Hi, Elena. Oh my gosh, I'm so glad you're here. Meet Erica. You're gonna talk to her later. It's great.

Erica Crawford

I love it. Jessica Nunn: I feel like patients wanna help you more than you think they do, so I always say just ask, right? Like, if I'm somewhere and I really loved my experience and they're like, "Hey, we're trying to grow the business here," or, "We would really love your review 'cause we'd love to have more patients like you," I think patients are gonna be like, "Oh my gosh, I'm so honored you asked." That's just my two cents.

Erica Crawford

I agree. I think that a happy patient, you know, they're gonna give you a review. We are—

Jessica Nunn

Are you seeing the one up there, Erica?

Erica Crawford

Yeah. I missed one. "What are your thoughts on Google Ads? How much should we invest monthly to increase revenue?" Man, that is a hard question. Yeah. You would need a full, like, analysis, 'cause it depends on your market and what you wanna do, and if that makes sense.

Meta is a lot cheaper than Google. Google is very much based of what your competitors are bidding on. Google's a bidding system, which is something not everybody understands, but so it depends. Is like 20 people running ads? Is it 100? Is it 200? Is it five?

So the budget varies so different per market and per procedure, and sometimes it doesn't make sense to do it. Like, if you're in Beverly Hills, for example, and you're like, "Oh, I really wanna do a facelift ad," I'm like, "Cool. You're gonna have to spend like four or five grand to be like pretty aggressive about it in Beverly Hills." Maybe we pick something like slightly more niche.

You know, like maybe like a facelift revision, or maybe we do like a neck lift, or maybe we go like even more niche, like a deep plane neck lift. Sometimes you have to be smart about your ads to look at it. It really just depends a lot on your market, unfortunately, and what the procedure is, so it's hard to give like a set answer.

I will say you could always start with, Instagram is obviously much cheaper. You could always try some Meta ads for non-surgical. Not for surgical procedures, but for non-surgical specifically. Spend a little less. You could try boosting some posts. Just make sure they follow Meta's guidelines. And that's a more inexpensive way to do it.

Jessica Nunn

A lot of practices are having a harder time bringing in revenue. People say it used to feel easier, and that's kind of to Erica's point at the beginning of the webinar about there's increased competition, right? Practices are having to fight harder for every patient, and I think that one of the things that we talk about the most with clients is, how do we get busier?

Our capacity is just not where it needs to be. How can we get busier? The marketing doesn't feel like it's working, whether we're tracking it, maybe we're not tracking it, maybe we don't have data around it. But you're not alone if you're having a hard time bringing in revenue or growing the practice. It's definitely like an industry-wide pain point right now.

Erica Crawford

Absolutely. Jessica Nunn: "Best version of QuickBooks for a single practitioner?" Yeah, so, QuickBooks Online, you guys. Practices up to a lot of revenue are using QuickBooks Online, and it's suitable for a one-provider practice as well. It has different levels, I will say.

You cannot use the level that's like the self-employed level, 'cause it doesn't have a balance sheet. So it's kind of the middle-of-the-road level, I don't know what it's called, that you should use. Setting up QuickBooks is not the most fun time you're ever gonna have, so this is a time that I would try to engage your CPA or a bookkeeper or someone to just get it started for you.

And then it might be something you can take over with some training, but we gotta do it right, and my preference is that an accountant do it for you. That's why I said hire a bookkeeper. But definitely it's better than a spreadsheet, so I would use QuickBooks Online.

Erica Crawford

Okay, perfect. All right, everybody. Thank you so much for staying with us. We love your questions. If you have more, you know how to reach out to us. We showed the QR codes earlier, and we're happy to help you. Otherwise, have a great rest of your day, and thank you for coming.